Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Shoulder Elbow Surg. 2021 Aug;30(8):1968-1976. doi: 10.1016/j.jse.2021.02.007. Epub 2021 Mar 4.
Amid rising health care costs and recent advances in surgical and anesthetic protocols, the rate of outpatient joint arthroplasty has risen steadily in recent years. Although the safety of outpatient total knee arthroplasty and total hip arthroplasty has been well established, outpatient shoulder arthroplasty is still in its infancy. The purpose of this study was to synthesize the current literature and provide further data regarding the outcomes and safety of outpatient shoulder arthroplasty.
A systematic review was conducted following the standard PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies that evaluated the outcomes of patients undergoing outpatient total shoulder arthroplasty (TSA) or reverse TSA. Meta-analysis was conducted using Mantel-Haenszel statistics to generate odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) comparing outpatient and inpatient shoulder arthroplasty.
Twelve studies were included, with a total of 194,513 patients, of whom 7162 were outpatients. Of the studies, 8 were level III and 4 were level IV. The average age of the outpatients was 66.6 years, and the average age of the inpatients was 70.1 years. The overall OR for complications was significantly lower in outpatients (OR, 0.40; 95% CI, 0.35-0.45) than in inpatients. There was no significant difference in rates of 90-day readmission (OR, 0.88; 95% CI, 0.75-1.03), revision (OR, 0.96; 95% CI, 0.65-1.41), and infection (OR, 0.93; 95% CI, 0.64-1.35) when comparing outpatients with inpatients.
Outpatient TSA, in an appropriately selected patient population, is safe and results in comparable patient outcomes to those of inpatient shoulder arthroplasty. Given the expected increase in the number of patients requiring TSA, surgeons, hospital administrators, and insurance carriers should strongly consider the merits of a cost- and care-efficient approach to total shoulder replacement.
随着医疗保健成本的上升和手术及麻醉方案的最新进展，近年来门诊关节置换术的比例稳步上升。虽然门诊全膝关节置换术和全髋关节置换术的安全性已得到充分证实，但门诊肩关节置换术仍处于起步阶段。本研究的目的是综合目前的文献，提供有关门诊肩关节置换术结果和安全性的进一步数据。
按照标准 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价。纳入的研究评估了接受门诊全肩关节置换术（TSA）或反向 TSA 患者的结果。使用 Mantel-Haenszel 统计进行荟萃分析，生成门诊和住院肩关节置换术比较的优势比（OR）及其相应的 95％置信区间（CI）。
纳入了 12 项研究，共有 194513 名患者，其中 7162 名是门诊患者。这些研究中有 8 项为 3 级，4 项为 4 级。门诊患者的平均年龄为 66.6 岁，住院患者的平均年龄为 70.1 岁。门诊患者并发症的总体 OR 明显低于住院患者（OR，0.40；95％CI，0.35-0.45）。门诊患者 90 天再入院率（OR，0.88；95％CI，0.75-1.03）、翻修率（OR，0.96；95％CI，0.65-1.41）和感染率（OR，0.93；95％CI，0.64-1.35）与住院患者相比无显著差异。
在适当选择的患者人群中，门诊 TSA 是安全的，并且其患者结果与住院肩关节置换术相当。鉴于需要 TSA 的患者数量预计会增加，外科医生、医院管理人员和保险公司应充分考虑采用成本效益和护理高效的方法进行全肩关节置换术的优点。
